UK Nonlinear News, May 1996

Application form for the Seventh IMA Conference on

MATHEMATICS IN MEDICINE AND BIOLOGY

10th-12th July, 1996
Oxford, UK

Please complete and return to:

Mrs. Pamela Bye, Conference Officer, The IMA, Catherine Richards House, 16 Nelson Street, Southend-on-Sea, Essex SS1 1EF, UK. Tel: +44 (0)1702 354020. Fax: +44 (0)1702 354111. Email: imacrh@v-e.anglia.ac.uk.



MALE/FEMALE ............         TITLE ..................

SURNAME ........................ FORENAMES .....................................

INSTITUTION AT WHICH EMPLOYED (in full, including address) .....................

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ADDRESS FOR CORRESPONDENCE .....................................................

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TELEPHONE NO: .......................... FAX NO: ...............................

EMAIL ADDRESS: .................................................................
(please write clearly)

CONFERENCE FEE ......................... RESIDENTIAL FEE .......................

LATE REGISTRATION FEE ......... DIETARY REQUIREMENTS ...........................

SIGNATURE .............................. DATE ..................................

GRADE (if IMA/IBS Member) ......................................................

Payment

Please note a VAT invoice will automatically be issued to all applicants wishing

to attend the conference.  If, however, you require your invoice to be addressed

to your accounts department or any other payer please give full details below:

................................................................................

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*Please charge my Access/Mastercard/Eurocard/Barclaycard/VISA/DELTA (delete as appropriate)

ACCOUNT NUMBER ................................... EXPIRY DATE .................

*If your card account address is different from the above address please enter here:

................................................................................

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Since email is not a secure medium, credit card details are transmitted entirely at your own risk. All cheques should be made payable to The Institute of Mathematics and its Applications


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Last Updated: 1st May 1996.